Provider Demographics
NPI:1649273574
Name:ROBATIN, MICHAEL F (MSN, CRNP)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:F
Last Name:ROBATIN
Suffix:
Gender:M
Credentials:MSN, CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:575 PIERCE ST
Mailing Address - Street 2:STE 101
Mailing Address - City:KINGSTON
Mailing Address - State:PA
Mailing Address - Zip Code:18704-5700
Mailing Address - Country:US
Mailing Address - Phone:570-718-8676
Mailing Address - Fax:
Practice Address - Street 1:575 PIERCE ST
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:PA
Practice Address - Zip Code:18704-5700
Practice Address - Country:US
Practice Address - Phone:570-718-8676
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-05-24
Last Update Date:2021-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PATP005727C363LF0000X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA576651Medicare UPIN
025851Medicare ID - Type Unspecified